Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | LSW0000007578 | TN |
NPI | 1003054446 |
---|---|
Provider Name | Ms. Tina Davenport Rowland |
First Address | Mountain Home, TN 37684-4000 |
Second Address | Mountain Home, TN 37684-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2009 |
Last Update Date | 22/01/2009 |